Feasibility and Safety of Adjuvant Chemotherapy for Resected Colorectal Cancer in Patients With Renal Insufficiency: A Pooled Analysis of Individual Patient Data from Five Japanese Large-scale Clinical Trials

Anticancer Res. 2023 Jul;43(7):3089-3095. doi: 10.21873/anticanres.16480.


Background/aim: The incidence of chemotherapy-related adverse events in colorectal cancer patients with renal insufficiency has been compared to patients with normal renal function in only a few studies. The purpose of this analysis was to verify the feasibility and safety of adjuvant chemotherapy for postoperative colorectal cancer patients with renal insufficiency.

Patients and methods: Adverse events and discontinuation of adjuvant chemotherapy for patients with curatively resected locally advanced colorectal cancer were examined using a combined database of individual patient data obtained from five large-scale clinical trials (n=4,106). The renal function of patients was classified into Level (L) 1-2: ≥60 ml/min and L3-4: <60 ml/min.

Results: As Grade 3 adverse events, hematological toxicities, such as neutropenia and anemia, and gastrointestinal disorders, such as diarrhea and vomiting, were significantly more frequent in the L3-4 group. Moreover, the time-to-treatment discontinuation in the L3-4 group was higher (hazard ratio=1.21, p=0.0012). T factor, N factor, and creatinine clearance level were found to be independent risk factors for the discontinuation of adjuvant chemotherapy. In the subgroup analysis of FOLFOX, neutropenia and diarrhea were significantly common in the L3-4 group, but neurotoxicities were not different. There was no significant difference in the discontinuation of adjuvant FOLFOX.

Conclusion: Adverse events of adjuvant chemotherapy in patients with resected colorectal cancer were associated with renal insufficiencies. Since adverse events have the potential to shorten the duration of treatment, especially when using chemotherapy without oxaliplatin, careful management, including dose reduction, may be important in patients with renal insufficiency.

Keywords: Colorectal cancer; adjuvant chemotherapy; chronic kidney disease.

Publication types

  • Meta-Analysis

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols* / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Chemotherapy, Adjuvant* / adverse effects
  • Colorectal Neoplasms* / complications
  • Colorectal Neoplasms* / drug therapy
  • Colorectal Neoplasms* / surgery
  • East Asian People
  • Feasibility Studies
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Fluorouracil / therapeutic use
  • Humans
  • Leucovorin / administration & dosage
  • Leucovorin / adverse effects
  • Leucovorin / therapeutic use
  • Neutropenia / chemically induced
  • Oxaliplatin* / administration & dosage
  • Oxaliplatin* / adverse effects
  • Oxaliplatin* / therapeutic use
  • Renal Insufficiency* / complications
  • Treatment Outcome


  • Fluorouracil
  • Leucovorin
  • Oxaliplatin

Supplementary concepts

  • Folfox protocol